Watch both of these two films. Pick one of them and discuss how the film is connected to the information in Chapter 4 of our e-text. You will need to log into our Berkeley library using your regular Blackboard log-on. The first film is 93 minutes. The second film is 31 minutes. They are both riveting. Skip the Cooking Channel and come and get cookin’ with us!!

https://www.kanopy.com/product/sickness-and-wealth

https://www.kanopy.com/product/when-bough-breaks

Chapter 4
Overview of the United States Healthcare System

Chapter Overview
Provides a general understanding of how the healthcare system works in the United States
Focuses on
Healthcare finance
Healthcare access
Healthcare quality
Comparative health systems

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Healthcare Finance
In 2016, the United States spent $3.3 trillion on healthcare services, representing 17.9% of GDP.
Estimated to reach 19.7% GDP by 2026
National health expenditure projected to grow 5.6% from 2017 to 2026
Increase driven by increase in prices for medical goods and services and increases in spending due to Baby Boomer population

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Healthcare Finance: Insurance
When ACA signed into law in 2010, 16.3%/49.9 million individuals uninsured
By 2016 uninsured rate dropped to 8.8%/28.1 million
Changes to ACA expected to result in increase in uninsured again
Most people in United States obtain insurance through their employer
Health insurance acts as an intermediary between patients and providers

Healthcare Finance: Direct Service
Federal, state, and local governments fund programs that directly provide care to individuals.
FQHCs
HIV/AIDS programs
Family planning programs

Healthcare Access
Access refers to ability to obtain needed services.
Key barriers to access
Lack of health insurance
Inadequate health insurance
Insurance coverage limitations
Workforce issues

Health Care Access: Uninsured and Underinsured
Key characteristics
Poor, low education, non-native, racial/ethnic minority, location, age, gender
Problems with being uninsured
Less access to care, less timely care, less likely to follow treatment recommendations due to cost
Underinsured do not have financial resources to cover the gap between what their insurance covers and their medical bills
Safety net providers serve many uninsured and underinsured

Healthcare Access: Insurance Coverage Limitations
High cost-sharing
Co-payments, deductibles, premiums
Reimbursement and visit caps
Service exclusions

Safety Net Providers
Serve disproportionately high numbers of uninsured, underinsured, and publicly insured patients
Public and private hospitals, community health centers, family planning clinics, and public health agencies

Healthcare Access: Workforce Issues
Provider shortages
Especially primary care and public health
Problem exacerbated by influx of newly insured individuals under the ACA
Uneven distribution of providers
Significant problem in rural areas
Several ACA provisions address these workforce issues

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Healthcare Quality
The United States spends more per person on health care but often ranks poorly on preventive and primary care healthcare measures.
IOM focuses on six areas to improve quality.
Safety, efficacy, patient-centeredness, timeliness, efficiency, and equity

Comparative Health Systems
(1 of 2)
Three common types of healthcare systems
Publicly financed, privately delivered national healthcare system (Canada)
Publicly financed and delivered national health systems (Britain)
Socialized insurance system with mandatory contributions and private delivery (Germany)

Comparative Health Systems
(2 of 2)
Type of health insurance design relates to key issues for patients
Affordability
Differences in access by income level
Waiting lists/wait times
Choice
Complexity of interacting with insurance system/paperwork
Patient satisfaction